Modifier 26


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Good Morning

I have a Vascular doctor who is insisting it is correct to append modifier 26 to surgical and office visit cpt codes such as 36471, 36475, 99213. (36471 & 36475 are being performed in the doctor's office.) I don't believe this is correct based on John Verhovshek's blog written August 2015. I've also read the CMS Physician Fee Schedule relative value guidelines which also supports John's information.

I feel that if I show the doctor the article, it may clear this up somewhat. I would just like to confirm that appending modifier 26 to the above codes is incorrect.

Can anyone provide any additional information that might be helpful?

Thanks very much!

Debbie Youngberg, CPC
You are correct. Upon reviewing mod 26 guidelines for these codes on the MPFSDB, they come up with an indicator of 0 which means the PC/TC applications are not applicable.

Professional/Technical Component: 0 x
About "Professional/Technical Component (Modifier 26 and HCPCS Modifier TC)"
This field provides an indicator identifying when the Professional (modifier 26) and Technical (modifier TC) Component applies.

What does "0" mean?
Physician service codes: This indicator identifies codes that describe physician services. Examples include visits‚ consultations‚ and surgical procedures. The concept of PC/TC does not apply since physician services cannot be split into professional and technical components. Modifiers 26 & TC cannot be used with these codes.

The total Relative Value Units (RVUs) include values for physician work‚ practice expense and malpractice expense. There are some codes with no work RVUs.

Hope it helps.